Bupropion versus SSRIs for Anxiety in MDDAccording to Papakostas and colleagues, bupropion (Wellbutrin and others) appears to work as well as selective serotonin reuptake inhibitors to treat anxiety in patients with major depressive disorder.

Baby Steps

December 2007

Science progresses in increments. If you or a loved one is ill, advances in medical therapeutics may seem painfully small and all too slow. Baby steps, so to speak.

Watching advances in biological psychiatry over the past year, we see the clichéd good news and bad. Several large, expensive federal initiatives—namely, CATIE, STAR*D, and STEP-BD—have expanded clinical knowledge in useful ways, but at the same time, have demonstrated that neither our scientific understanding nor our intervention technology is as potent as we wish.

The huge undertaking of revising our diagnostic nomenclature—creating DSM-V—has set sail. Most likely, by the time DSM-V is published, psychiatric diagnoses will be informed by neurobiological discoveries. This will allow identification of more homogeneous diseases than our current broad syndromes and enable treatments to be more focused and targeted. We wait—and hope.

The U.S. healthcare system remains a disaster zone, as "managed care" serves to deny and impede good practice and while a substantial proportion of our population remains without coverage. Change will come—but how and when are open questions. The process will be highly political, given the trillion-plus dollars at play nationally. Again, we wait—and hope.

BTP now closes its 30th year and looks forward to decades more of reporting on little and big steps of clinical science—to help you and the patients in your care. I love this job and the people who make it possible. I thank our "Tucson team," which has become a family. We enjoy our work and one another immensely. The team includes Heather Hopkins, Amy Boynton, and Melissa Manas—and their growing families. I thank Dave Labrecque, who has made our audio option a reality; Susanne Austin, who maintains our website; my wife Patty, who records the audio with me; and the very efficient team at our printer, West Press.

I thank our subscribers and wish you and yours safe, enjoyable holidays and a healthy, prosperous New Year. Psychiatry has many hurdles and challenges, including historical stigma. But this is also an exciting era. Let the adventure continue.

Disclaimer: This publication provides general coverage of its subject area. It is sold with the understanding that the authors and publisher are not engaged in rendering medical or other professional advice or services. If medical or other expert advice is required, a competent professional should be consulted. The authors and publisher shall not be responsible for any damages resulting from any error, inaccuracy, or omission contained in this publication.